Secondary Caesarean sections and instrumental deliveries are performed for failure of progress of labour or for suspected fetal distress. One would hypothesize that a high intervention rate during labour would result in optimal fetal outcome. In this study, we assessed whether higher rates of secondary caesarean sections and assisted vaginal deliveries per hospital are related to an improved perinatal outcome.
We studied the deliveries of all nulliparous women with term, singleton, cephalic pregnancies, carrying a living fetus without congenital abnormalities at the start of delivery in all 98 Dutch hospitals from January 2005 to December 2007. Data were obtained from the Dutch Perinatal Registry. This registry contains the linked and validated data of the national obstetric database for gynaecologists and the national neonatal/paediatric database. For each hospital, total intervention rates (which included secondary caesarean sections and assisted vaginal deliveries) for the indications suspected fetal distress or dystocia, were correlated to adverse perinatal outcome rates, defined as intrapartum mortality, apgar score <7 and/or NICU admission) using the Pearsons correlation coefficient.
We studied 258.676 deliveries. The total intervention rates per hospital ranged from 23% to 55%. No significant correlation was found between total intervention rates and adverse perinatal outcome per hospital (Fig.1
, r=−0.171, p=0.093). Also the rates of interventions made solely for the indication fetal distress were not significantly correlated to adverse perinatal outcome (r=+0.174, p=0.086). Interestingly, higher intervention rates for the indication dystocia per hospital were significantly related to lower perinatal adverse outcome rates (r=−0.236, p=0.019).
There appears to be a wide variety in rates of secondary caesarean sections and assisted vaginal deliveries between hospitals in the Netherlands. Overall, higher intervention rates do not significantly improve perinatal outcome.
© 2012 Mosby, Inc. Published by Elsevier Inc. All rights reserved.